Brighten Up

Why don't all spots look the same?

Even though most spots are caused  or exacerbated  by the sun, they take different forms. See a dermatologist if a new kind of skin change shows up (to rule out anything dangerous such as melanoma), but here's a guide to help you determine what's what.

Freckles: These are small tannish spots that are usually less than half a centimeter. They may come and go, fading in the winter and darkening in the summertime.

Lentigines: Known as age or liver spots, these small-to-medium brown areas multiply as you get older, popping up most often on the face, hands, and chest  all places with maximum exposure to sun.

Uneven skin tone: Rather than a few specific spots, this involves larger areas of pigmentation that make your skin look darker in some areas, lighter in others.

Post-inflammatory hyperpigmentation: These are dark spots that develop after pimples, bug bites, or other flare-ups, and then stubbornly remain long after the initial inflammation has healed.

Melasma: More patchy than spotty, these brown outbreaks are hormone related, so they are likeliest to appear (on the cheeks, forehead, and around the lips) when a woman is pregnant or taking hormone replacement or birth control pills.

How can I treat spots at home?

Try hydroquinone. This bleaching agent, available in department and drugstores or by prescription, works by interfering with an enzyme that helps your skin produce melanin, the brown pigment that shows up as spots. (Dr. Hirsch recommends using hydroquinone in conjunction with a prescription-strength retinoid, such as Renova or Tazorac, which helps lighten by exfoliating the skin.) "Hydroquinone is the gold standard for pigmentary disorders," says Rebat Halder, M.D., professor and chairman of the department of dermatology at Howard University. Look for it over the counter in concentrations up to 2 percent; prescription versions will usually have 4 percent.

Tip: Be careful to apply it only on the specific areas you want to lighten. "Hydroquinone is bleach," says Dr. Hirsch. "It can't distinguish the skin you want to bleach from the skin you don't." For precise application, she recommends using a Q-tip  or even an inexpensive eyeliner brush  to dot it directly on the spots.

Consider the alternatives. If you are sensitive to hydroquinone or prefer not to use it (see "Is Hydroquinone Safe?" below), you can improve the appearance of spots (probably less dramatically) with other over-the-counter treatments, including kojic acid, licorice extract, mulberry, vitamin C, and soy. "These are excellent alternative or additional therapies for pigmentation," says Dr. Wattenberg. "They do not all directly inhibit the enzyme that produces melanin, but they often produce results and are worth a try."

Retinols  the less potent, OTC form of retinoids  are also worthwhile options, especially if your skin can't tolerate the stronger versions. But keep in mind that results will be more about radiance and evenness (think softer, less noticeable spots), and less about the pigmentation being completely bleached away, says Dr. Hirsch.

To try: Neutrogena Visibly Even Night Concentrate ($12, drugstores).To skip: So-called brightening or lightening cleansers. They won't hurt you  but they also won't do anything more than wash your face. "They're not on the skin long enough to make a difference," says Dr. Hirsch.

Protect your results. "Sunscreen is essential," says Paul M. Friedman, M.D., clinical assistant professor of dermatology at the University of Texas at Houston. "Sun exposure can trigger production of the pigment you are trying to eliminate  and almost any treated dark spot can recur if exposed to UV light." And, yes, you still need the stuff if you have darker skin. A recent Johnson & Johnson study of hyperpigmentation in African-Americans found that participants who simply added an SPF 30 sunscreen to their daily routine (and used no other additional treatments) saw significant improvement in their pigmentation, skin tone, and radiance after eight weeks.

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